Success & concerns in Hodgkin Lymphoma treatment
Treatment of early-stage Hodgkin lymphoma (HL), which consists of a combination of chemotherapy and radiotherapy (RT)30 31 is extremely successful, with at least nine of ten patients being cured. However, toxicities that surface years after treatment are of major concern, and mainly include second cancers32 33 as well as pulmonary 34and heart-related diseases35 36.
Tailoring patient treatment: the impact of PET scans after chemotherapy
The groundbreaking H10 trial studied the adjustment of treatment based on PET scan results after two chemotherapy cycles. For patients with a negative scan, radiation therapy (RT) was omitted to avoid long-term side effects. Among patients with a favourable prognosis and a negative PET scan, five-year progression-free survival was 99% with RT after chemotherapy versus 87% with chemotherapy alone29 indicating the necessity of RT. The ten-year follow-up data confirmed that the omission of INRT was associated with lower progression-free survival, although no differences in terms of survival emerged.
Improving patient outcomes: finding the right balance between treatment and toxicity
Conversely, the trial succeeded in showing that patients with a positive PET scan after the first two cycles of chemotherapy achieved better outcomes when given an intensified chemotherapy combined with RT. Specifically, the PFS rate at five years was 91% for the patients who received intensified combination therapy, versus 77% for those who received standard combination therapy.
The ten-year follow-up data showed no statistically significant differences between standard and
intensified therapy in terms of progression-free survival and overall survival.
29 André, M. P. E. et al. Early positron emission tomography response-adapted treatment in stage I and II hodgkin lymphoma: Final results of the randomized EORTC/LYSA/FIL H10 trial. Journal of Clinical Oncology 35, 1786–1796 (2017).
30 Fermé, C. et al. Chemotherapy plus Involved-Field Radiation in Early-Stage Hodgkin’s Disease. New England Journal of Medicine 357, 1916–1927 (2007).
31 Engert, A. et al. Reduced treatment intensity in patients with early-stage Hodgkin’s lymphoma. N Engl J Med 363, 640–652 (2010).
32 E Brusamolino 1, A. P. A. C. K. M. S. E. O. G. P. F. L. R. M.-E. C. D. B. M. L. F. M. C. B. The risk of acute leukemia in patients treated for Hodgkin’s disease is significantly higher aft [see bined modality programs than after chemotherapy alone and is correlated with the extent of radiotherapy and type and duration of chemotherapy: a case-control study – PubMed. Haematologica Sep;83(9):812-23 https://pubmed.ncbi.nlm.nih.gov/9825578/ (1998).
33 Schaapveld, M. et al. Second Cancer Risk Up to 40 Years after Treatment for Hodgkin’s Lymphoma. New England Journal of Medicine 373, 2499–2511 (2015).
34 Bledsoe, T. J., Nath, S. K. & Decker, R. H. Radiation Pneumonitis. Clin Chest Med 38, 201–208 (2017).
35 Hancock, S. L., Hoppe, R. T. & Tucker, M. A. Factors Affecting Late Mortality From Heart Disease After Treatment of Hodgkin’s Disease. JAMA 270, 1949–1955 (1993).
36 De Bruin, M. L. et al. Increased Risk of Stroke and Transient Ischemic Attack in 5-Year Survivors of Hodgkin Lymphoma. JNCI: Journal of the National Cancer Institute 101, 928–937 (2009).
